People who are dying may move towards death over longer or shorter periods of
time and in different ways. Different causes of death result in different paths
toward death.

The pathway to death may be long and slow, sometimes lasting years, or it may
be a rapid fall towards death (for example, after a car accident or sudden heart attack) when the
chronic phase of the illness, if it exists at all, is short. The peaks and
valleys pathway describes the patient who repeatedly gets better and then worse
again (for example, a patient with AIDS or leukemia). Another pathway to death
may be described as a long, slow period of failing health and then a period of
stable health (for example, patients whose health gets worse and then stabilizes
at a new, more limiting level). Patients on this pathway must readjust to losses
in functioning ability.

Deaths from cancer often occur over a long period of time, and may involve
long-term pain and suffering, and/or loss of control over one's body or mind.
Deaths caused by cancer are likely to drain patients and families physically and
emotionally because they occur over a long period of time.

Anticipatory grief is the normal mourning that occurs when a patient or
family is expecting a death. Anticipatory grief has many of the same symptoms as
those experienced after a death has occurred. It includes all of the thinking,
feeling, cultural, and social reactions to an expected death that are felt by
the patient and family.

Anticipatory grief includes depression, extreme concern for the dying person,
preparing for the death, and adjusting to changes caused by the death.
Anticipatory grief gives the family more time to slowly get used to the reality
of the loss. People are able to complete unfinished business with the dying
person (for example, saying "good-bye," "I love you," or "I forgive
you").

Anticipatory grief may not always occur. Anticipatory grief does not mean
that before the death, a person feels the same kind of grief as the grief felt
after a death. There is not a set amount of grief that a person will feel. The
grief experienced before a death does not make the grief after the death last a
shorter amount of time.

Grief that follows an unplanned death is different from anticipatory grief.
Unplanned loss may overwhelm the coping abilities of a person, making normal
functioning impossible. Mourners may not be able to realize the total impact of
their loss. Even though the person recognizes that the loss occurred, he or she
may not be able to accept the loss mentally and emotionally. Following an
unexpected death, the mourner may feel that the world no longer has order and
does not make sense.

Some people believe that anticipatory grief is rare. To accept a loved one's
death while he or she is still alive may leave the mourner feeling that the
dying patient has been abandoned. Expecting the loss often makes the attachment
to the dying person stronger. Although anticipatory grief may help the family,
the dying person may experience too much grief, causing the patient to become
withdrawn.